Tools for Identifying Cancer Pain of Predominantly Neuropathic Origin and Opioid Responsiveness in Cancer Patients

Mercadante, Sebastiano; Gebbia, Vittorio; David, Fabrizio; Aielli, Federica; Verna, Lucilla; Casuccio, Alessandra; Porzio, Giampiero; Mangione, Salvatore; Ferrera, Patrizia

doi:10.1016/j.jpain.2008.12.002

Cited by 60 publications

(60 citation statements)

References 33 publications

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“…90 Other scales (Northwick Park Neck Pain Questionnaire, NPQ; Neuropathic Pain Questionnaire Short Form, NPQ-SF; Neuropathic Pain Symptom Index, NPSI) have been evaluated as useful tools to facilitate communication between physicians. 91 Limited data supporting the use of DN4 scale for diagnosing NCP exist. 92 Diagnosing NCP still remains problematic and many factors are responsible for this.…”

Section: 282987mentioning

confidence: 99%

“…NCP does respond to opioids, but usually higher doses are needed. 91 In the following paragraphs, data regarding NP therapy in general (regardless etiology) are presented, as some of the available treatment options may also be applied to cancer patients, suffering from pain characterized by neuropathic elements. During NCP management, an important recommendation in initiating pharmacological therapy is to introduce one drug at a time, with gradual upward titration, according to patient's response.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

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Pharmacological Treatment of Neuropathic Cancer Pain: A Comprehensive Review of the Current Literature

et al. 2011

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Neuropathic cancer pain (NCP), commonly encountered in clinical practice, may be cancer-related, namely resulting from nervous system tumor invasion, surgical nerve damage during tumor removal, radiation-induced nerve damage and chemotherapy-related neuropathy, or may be of benign origin, unrelated to cancer. A neuropathic component is evident in about 1/3 of cancer pain cases.Although from a pathophysiological perspective NCP may differ from chronic neuropathic pain (NP), such as noncancer-related pain, clinical practice, and limited publications have shown that these two pain entities may share some treatment modalities. For example, co-analgesics have been well integrated into cancer pain-management strategies and are often used as First-Line options for the treatment of NCP. These drugs, including antidepressants and anticonvulsants, are recommended by evidence-based guidelines, whereas, others such as lidocaine patch 5%, are supported by randomized, controlled, clinical data and are included in guidelines for restricted conditions treatment. The vast majority of these drugs have already been proven useful in the management of benign NP syndromes. Treatment decisions for patients with NP can be difficult. The intrinsic difficulties in performing randomized controlled trials in cancer pain have traditionally justified the acceptance of drugs already known to be effective in benign NP for the management of malignant NP, despite the lack of relevant high quality data. Interest in NCP mechanisms and pharmacotherapy has increased, resulting in significant mechanism-based treatment advances for the future. In this comprehensive review, we present the latest knowledge regarding NCP pharmacological management. n INTRODUCTIONFollowing EFIC's (European Federation of IASP Chapters) declaration in 2001, pain is not a symptom but a disease in its own right, necessitating appropriate treatment. The word pain usually refers to a discrete sensory experience, triggered by an identifiable set of ''painful'' stimuli, acting on a unique or stable ''pain'' pathway and eliciting an invariant sensation. However, pain, and particularly neuropathic pain (NP) can also exist as a diverse group of complex phenomena of unpleasant and distressing nature. NP encloses numerous complicated neurobiologic constituents and reflects potentially dynamic mechanisms, interacting at multiple neuraxial sites. 1Modern neurobiological techniques have led to tremendous progress in the exploration of pain pathogenetic mechanisms. [2][3][4] Research indicates that pain can be produced in multiple ways, at different locations, co-existing between and across various pathological conditions. 5,6 Novel therapeutic targets have been discovered and are used by the pharmaceutical industry for the construction of highly specific molecules, acting as potential innovative analgesics. Recent targets' application, specific to precise NP mechanisms, will very soon enable treatment to be focused at particular mechanisms, introducing a mechanism-based therap...

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Section: 282987mentioning

confidence: 99%

Section: Pharmacological Treatmentmentioning

confidence: 99%

Pharmacological Treatment of Neuropathic Cancer Pain: A Comprehensive Review of the Current Literature

et al. 2011

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“…Opioid titration significantly decreased pain intensity in the three categories of baseline pain intensity, particularly in patients with severe pain (Table 1). The mean time to reach dose stabilisation (T1) was 2.8 days (range [1][2][3][4][5][6]. No statistical differences between pain categories were observed (2.2, 3 and 3.4 days, respectively).…”

Section: Resultsmentioning

confidence: 92%

“…The original methods are described elsewhere. 5 Before starting the treatment (T0) pain intensity in the past 24 h (average pain) was measured by using a numerical scale from 0 to 10, choosing a number from 0 (no pain) to 10 (the worst pain imaginable). Patients were grouped in the ranges proposed by Fainsinger et al 1 : mild, 0-3; moderate, 4-6; and severe, 7-10.…”

Section: Methodsmentioning

confidence: 99%

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Does pain intensity predict a poor opioid response in cancer patients?

Mercadante

Gebbia

David

et al. 2011

European Journal of Cancer

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dictive factor of poor opioid response in advanced cancer patients, as suggested by a recent work.Methods: A secondary analysis of one-hundred-sixty-seven patients referred for treatment of cancer-related pain was conducted. Pain intensity at admission was recorded and patients were divided in three categories of pain intensity: mild, moderate and severe.Patients were offered a treatment with opioid dose titration, according to department policy. Data regarding opioid doses and pain intensity were collected after dose titration was Conclusion: Baseline pain intensity does not predict the outcome after an appropriate opioid titration. It is likely that non-homogeneous pain treatment would have biased the outcome of a previous work.

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Prevalence of pain and relative diagnostic performance of screening tools for neuropathic pain in cancer patients: A cross‐sectional study

Pérez

Sánchez-Martínez

Ballesteros

et al. 2014

European Journal of Pain

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Background: Neuropathic pain can be overlooked in cancer patients. The advent of screening tools can help in recognizing it. However, little is known about their relative diagnostic performance and factors that affect it. This study evaluated the prevalence of neuropathic pain using several diagnostic strategies in cancer patients undergoing chemotherapy. Methods: Patients attending the Oncology Unit of the investigators' site to continue their chemotherapy schedule were systematically screened for this cross-sectional study. Before starting chemotherapy drugs, pain specialists made a clinical diagnosis of neuropathic pain (either disease related, treatment related or comorbid) and medical oncologists administered three validated screening tools. Their relative diagnostic performance and the impact of some pain features on it were analysed using multivariate statistical methods. Results: From a total of 358 patients, 194 (54.2%) suffered from pain and 73 (20.4%) had a clinical diagnosis of pure neuropathic or mixed pain. Among the screening tools, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) was more specific (93.4%), although less sensitive (68.1%) than the Douleur Neuropathique in 4 Questions (DN4) (sensitivity: 87.5%, specificity: 88.4%). Interestingly, the specificities of these two instruments did not differ in patients with mild pain, while the DN4 remained to be more sensitive than the LANSS regardless of pain severity. Conclusions: Neuropathic pain is common in cancer patients undergoing chemotherapy. The DN4 might be of great help for the early detection of patients at risk because of incipient chemotherapy-related neuropathies and the LANSS to rule out neuropathic pain in patients with complex pain conditions.

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Tools for Identifying Cancer Pain of Predominantly Neuropathic Origin and Opioid Responsiveness in Cancer Patients

Cited by 60 publications

References 33 publications

Pharmacological Treatment of Neuropathic Cancer Pain: A Comprehensive Review of the Current Literature

Pharmacological Treatment of Neuropathic Cancer Pain: A Comprehensive Review of the Current Literature

Does pain intensity predict a poor opioid response in cancer patients?

Prevalence of pain and relative diagnostic performance of screening tools for neuropathic pain in cancer patients: A cross‐sectional study

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